Do Rural–Urban Disparities Translate into Nursing Complexity at Hospital Admission? Evidence from a Single Tertiary-Care Pediatric Hospital in Italy

Background/Objectives: Rural–urban disparities are well documented in pediatric healthcare, influencing access, service organization, and outcomes. However, whether these differences extend to the domain of nursing care remains unclear. This study examined the association between degree of urbanization and nursing complexity among children admitted to a single tertiary-care pediatric hospital, comparing clinical, organizational, and nursing characteristics across geographic groups. Methods: Routinely collected electronic nursing documentation and hospital administrative records were retrospectively examined in a tertiary-care pediatric hospital in Rome, Italy. Children aged 2 to <18 years were consecutively included. Degree of urbanization was defined using the ISTAT-derived DEGURBA classification. The study outcome for nursing complexity corresponded to the number of nursing diagnoses documented at hospital admission. Descriptive analyses and a multivariable negative binomial regression model assessed the association between urbanization and nursing complexity, adjusting for age, sex, DRG weight, number of medical diagnoses, and chronic conditions. Results: Among 1652 pediatric hospitalizations, those from rural areas showed a higher clinical burden, with significantly higher DRG weight and more chronic conditions, but nursing complexity did not differ significantly across geographic groups. In the multivariable model, degree of urbanization was not independently associated with nursing complexity for admissions from towns and suburbs (IRR = 0.93, 95% CI 0.82–1.04, p = 0.211) or rural areas (IRR = 1.00, 95% CI 0.84–1.20, p = 0.966), compared with those from cities. Higher DRG weight (IRR = 1.11, 95% CI 1.05–1.17) and a greater number of medical diagnoses (IRR = 1.17, 95% CI 1.11–1.25) were positively associated with nursing complexity, whereas the number of chronic conditions showed an inverse association (IRR = 0.90, 95% CI 0.84–0.96). Conclusions: In this single-center sample, rural–urban differences in clinical burden are not accompanied by statistically detectable differences in nursing complexity at hospital admission. Despite a higher clinical burden among children admitted from less urbanized areas, nursing complexity does not appear to differ significantly across geographic groups. Standardized nursing data enhance the ability to compare admission-level care needs across geographic contexts, enabling more precise and stratified population and public health analyses.